A Second Chance

thumbnailWilliam Humphrey was 47 years old when he had a seizure at work. After his initial evaluation in the ER, an MRI was obtained. This revealed he had two fairly large circular cystic masses in his left frontal lobe, very near his speech area.

Initially I thought they might be a spread of cancer from somewhere else in his body. And so, I ordered additional CT scans to see if a cancerous growth was lurking unnoticed. But these were negative.

They did not have the appearance of a primary brain tumor, so I considered that they might represent an infection. This seemed possible since Billy had recently been treated for a sinus infection.

And so, after discussing this with he and his wife Donna, I decided to take him to surgery to find out what they were and to remove them completely if I could.

As I exposed and biopsied the larger of the two masses, the appearance was all too familiar. It looked like a malignant astrocytoma. I initially biopsied the edge of the tumor and then at a point deeper knowing this would give the pathologist a greater chance of making an accurate diagnosis.

As I waited for the pathologist to call I proceeded to remove the larger of the two masses, certain it was brain cancer.

At this point, the pathologist, Charlie called in to the OR… ‘The first specimen from the edge of the tumor doesn’t have any brain tissue in it, and there is no signs of infection either’, he said.

A moment later he called back and said, ‘The second, deeper biopsy contains only some gliosis (or brain scar tissue), but no tumor’.

I was stunned. So, I biopsied another area of the ‘tumor’.  ‘Negative’, The pathologist reported. At this point I used the intraoperative ultrasound to localize the second, smaller cyst and biopsied it. Again it had the appearance under the microscope, which I had seen a thousand times before. And again, the voice on the intercom in the OR reported, ‘negative for tumor’!

At this point it was hard to justify in my mind resecting the second ‘tumor’ since the back edge of it was right up against the speech area of Billy’s brain.

I stood there in silence, wondering if I had done the right thing. Since there was some blood within these masses, maybe they just represented resolving areas of benign hemorrhages of the brain, which can occur, sometimes for no reason.

As I voiced aloud that I had not done anything for Billy, the anesthesiologist snapped back at me. ‘ What do you mean you didn’t do anything for him? You are going to give him and his wife the best news they could have hoped for’…. I had to agree.

When I walked into the surgical waiting room, Donna and the rest of the family immediately got up out of their chairs to meet me half way. When I told her there was no tumor, she looked as shocked as I had been.

Actually she had a somewhat twisted and quizzical look on her face, as though I might be playing a very sick joke on her. ‘No’, I said as if reading her mind. ‘All the biopsies I sent to the pathologist were negative’. I then proceeded to tell her what had transpired.

I told them how I removed the larger of the two lesions, but since the biopsies were negative I decided not to risk attempting to remove the second. Donna quickly said, pointing to her father-in-law, ‘You had been praying that the tumor would disappear’!

They were all grateful, of course, but still in a state of shock. When I returned to the waiting room to let them know Billy was awake and perfectly fine, Donna remarked, ‘I saw that cross around your neck and know that you are a believer…and a miracle just happened tonight’. I nodded, though somewhat doubtful, I have to admit, and turned to return to the OR.

On Tuesday of the following week, I called Chris, one of the pathologists. He informed me that he had just been handed the permanent sections and he would ‘call me back in 10.’

When my cell phone rang 10 minutes later I answered and heard Chris’ voice on the other end. ‘Hal’, he said, and as he paused I knew what he was about to tell me was not good news. ‘I’ve looked at the most recent slides and on specimen #3, I see what looks like at least a Grade III malignant astrocytoma

I felt as though I had just been punched in the gut and had the wind knocked out of me. ‘But, I’m not 100% sure, he said ‘so I want to send the case out for a second opinion’.

That afternoon as I walked into the ICU, Billy looked great and said, ‘Thanks for operating on my brain and I’m ready to go home’ I told he and Donna the pathologist had looked at the permanent slides but still was uncertain so he wanted to send them out for a second opinion.

Billy remained up beat but Donna looked at me, not convinced, and said, ‘Should we be concerned?’ I’m sure I would make a lousy poker player, because all I could muster was, ‘Well no news is good news”.

As I left the ICU the radiologist, Yair called me and said he and Chris were going over the case and would I mind coming by as well.

As I sat looking at the MRI, I kept thinking, ‘I’m going to have to take that young guy back to the OR to remove that second tumor and I’ll probably damage his speech center in the process.

I pointed out to Yair and Chris where I had taken my biopsies, and then drifted off to the thoughts in my brain not really paying attention, as Yair was going on about how the characteristics of the tumor really did not look like a malignant astrocytoma.

In my other ear Chris was reiterating the pathology findings, only partly speaking to me, and more just talking aloud to himself.

I then blurted out, somewhat angrily, ‘OK so what do I do?’ Of course I knew I would have to be the one to decide.

As I drove home that evening, it occurred to me that if I ever needed to pray for a patient, it was for Billy. That either God would cure him or if I had to re-operate on him, God would guide my hands remove the tumor completely without complication.

That night I thought about another patient, Dennis Parker, whom I had operated on and how his blindness was inexplicably cured. I remembered how very limited my abilities were and that it was God who succeeded where I had failed.

Once again, I knew any miracle that might happen in Billy’s case would not come from me. So I got down on my knees and prayed some more.

Later that week, I received the consultant’s interpretation. Billy had an astrocytoma, no less than a Grade 3 out of 4. Since it was Thursday and there wouldn’t be anything I could do until the following week, I decided to wait until Monday to call Donna and Billy.

On Monday I called and spoke to Donna. I informed her of the results and that we should re-operate and aggressively remove what tumor remained. She asked, ‘When should we do this?’ I replied, ‘It might as well be tomorrow.” She agreed.

Billy was readmitted that day and I ordered a follow-up MRI. That evening I reviewed his scan and discovered the tumor had already begun to spread. In fact, its appearance now was more aggressive looking than it was initially.

My former partner, Kevin and I used to say that if you operated on a malignant astrocytoma, you had better take it all out, otherwise it would be like shooting a bear with a .22 caliber gun… all you’ll do is make him angry.

The following morning I awoke before 5am, unable to sleep. I reviewed Billy’s MRI again and realized the surgical approach I took the first time was probably not ideal to remove the secondary tumor.

And I was right. Taking a different approach allowed me to remove all of the visible tumor I could see under the surgical microscope. I only prayed that I wasn’t so aggressive that I damaged Billy’s ability to speak.

The following day, I found him sitting up in his ICU bed using his computer. He proceeded to tell me that only problem he had was that only very occasionally he would have some difficulty finding the word he wanted to say but was able to use a another, similar word instead.

His postoperative MRI looked quite good. In all I had removed at least if not more than 98% of the tumor that was present on the preoperative scan.

So, looking back you might ask why didn’t a miracle happen. In fact many people seem to believe that only by a miraculous cure can we be certain of God’s goodness. This unfortunately, is a human precondition we try force on God. (This likely was true in the time of Jesus as well!)

I would propose that a miracle did happen; although we really shouldn’t have to see miracles to know that eternal life is much more precious than our imperfect physical lives anyway.

In fact, by getting the diagnosis wrong in the first place caused me use using a different approach during his second operation, which gave Billy a longer time on earth to spend with his wife and family… three years to be exact….

Billy and Donna fought his cancer through radiation and multiple rounds of chemotherapy with remarkable results. However, earlier this year he wound up in the hospital with increasing difficulty speaking.

A follow-up MRI revealed the tumor had finally recurred and had begun to spread to the opposite side of his brain. They were willing to undergo more surgery but I told them that, honestly I didn’t believe it would have a significant impact.

And what was more I told them it would likely damage what remaining ability to speak that he had left.

They decided on another round of chemotherapy, but his condition continued to deteriorate and he passed away several months later… although, and I am certain of this, to a new and everlasting life.

 “It is the spirit that gives life, the flesh is of no avail; the words that I have spoken to you are spirit and life.”John 6:63

Tale of Two Sisters

Some time ago I operated on two patients. Both were women. Both were in there 60’s. Both had meningiomas of the brain. And in both cases their tumors grew back after surgery. Interestingly both had elderly husbands that passed away during the course of their illnesses.

Both were happy women, full of life…they could have been sisters.

Miriam Wilson had been developing some memory problems for some time. When she initially saw her primary care physician he told her husband what he had feared…she might be developing Alzheimer’s disease. Towards the end of 2006, however an MRI scan was performed which revealed that in fact she had a large ‘benign’ brain tumor.

She had an appointment to see a neurosurgeon after New Years day, 2007, but because her condition deteriorated so quickly in late December, her husband Carl brought her to the Emergency Room at my hospital. On arrival the physician on duty found she had significant paralysis of the right side of her body and was so difficult to arouse, he reported to me by phone, she was somewhat comatose.

In fact her condition was so serious within hours of arriving at the hospital she had to be intubated and placed on the ventilator. I made plans to take her immediately to the operating room to remove her tumor.

Following surgery, Miriam woke up and in time she became her usual happy, almost comical self. Her weakness improved as well.

Unfortunately, because the length of her surgery was so long, 7 hours to be exact and because I had to replace her natural skull with an artificial plate she developed and infection which persisted despite antibiotics. So, two months after her initial emergency surgery, I had to take her back to the operating room and remove this plate.

I tried to avoid doing this because I knew it would leave a large sunken area in the frontal part of her head. In spite of this obvious cosmetic defect, Miriam was her usual carefree self.

Fortunately I would able to reconstruct her skull once the infection cleared but Miriam would have to wait 6 months before that could take place.

Inexplicably, while Miriam waited to have this surgery, she began developing memory problems once again, but not because the tumor had grown back.

Ultimately I replaced the defect in her skull and her memory problem reversed within 6 weeks.

Miriam then continued to do well, and I did not hear from her for about two years. It was then that she developed an inability to speak. A repeat MRI scan showed that the tumor had come back. Not only that but it was larger than it was when I had first operated on her.

This surgery was without complication and ultimately she recovered and once again brought a smile to my face every time I saw her.

You would think being through everything she had she would have become somewhat bitter or even angry. But this was never the case. She always had a smile and laughed through it all.

At this point I thought for sure I had seen Miriam for the last time.

This was not to be the case, however.

Two years later almost to the day, Miriam wound up in the hospital once again. This time she had developed not only a recurrence of the infection, but it had spread to the surface of her brain as well.

Once again I took her back to surgery, this time, to clear up the infection.

Two days after surgery she was sitting up in her bed laughing and making me smile as she shook off having had to undergo her fifth major brain operation in less than five years.

Carla Winters was the other ‘sister’ I had operated on. She had a similar course that Miriam had, having developed an infection after a very long brain operation. She too had to have a portion of her skull removed although it wasn’t as damaging cosmetically.

Her tumor, too, recurred and I had to perform another surgery to remove it, although Carla’s tumor was much more difficult to remove completely because of where it was located.

The tumor had grown in between the two halves of the brain straddling a major vein. Any damage to this vein would result in either a major stroke or death.

As time passed, this vein gradually occluded to the point where the brain developed alternate paths of circulation. Because of this, I believed it was possible to remove that section of the occluded vein along with the remaining tumor without causing any complication.

Within a week of Miriam’s last surgery, I operated on Carla Winters for her fifth major brain operation as well. The surgery went extremely well. I was able to remove the entire remaining tumor. Unfortunately, the outcome was not what either of us had expected.

After surgery, I was completely shocked to discover Carla was completely paralyzed on the left side of her body. Because of this she would never walk again.

Initially I had hope she would recover and I encouraged her to work hard at rehabilitating but after a month of intensive physical therapy, she did not have any meaningful improvement.

Three months after her surgery she was hospitalized again.

When I went into see her she appeared weak, discouraged, and completely exhausted.

After speaking with her and her family it was clear she had accepted the finality of her condition. She was tired of fighting, and in this moment I think she missed her husband most of all. Collectively they had decided to move her to inpatient hospice.

As I talked to her and held her paralyzed left hand I felt sorrow. Carla was in this condition because of a surgery I had performed and there wasn’t anything I could do to reverse it.

Not knowing what to say I looked at her and told her I would see her again someday. Her eyes seemed to tear up a bit as she thanked me for all I had done.

As tears began to well up in my eyes, I told her I loved her and she replied the same. I leaned over and gave her a kiss on her cheek and turned and walked away.

Carla was in hospice less than a week before she passed.

Several weeks later, Miriam returned to the hospital because of a seizure. After she was placed on an anti-seizure medication a follow-up MRI scan was performed. I was dismayed and saddened to discover her tumor had recurred again. Not only that but the tumor had spread all over her brain.

Had I not known her initial diagnosis I would have thought she had cancer.

I sat down with her to discuss her options. She smiled broadly as she always did, but as I revealed to her the true nature of her condition she stopped smiling and began to get a bit choked up as she realized there wasn’t much I could do.

So, rather than risk a major degree of paralysis or loss of speech she decided to go home, be comfortable, ready to accept the inevitable whenever that would be.

She thanked me as I stood up. I leaned over and gave her a hug and said goodbye.

Miriam and Carla were two amazing women who were inspirational in so many ways. They were both vibrant and determined. They were hopeful and both persevered despite seemingly overwhelming odds. In the end, they accepted the inevitable and even embraced it, I believe, as part of God’s plan.

Soon, these ‘sisters’ would meet each other.

And one day, I too, hope to see their smiling faces once again.

A Crack in my Window

A while back on a Saturday night, I received a text about a patient in the emergency room. I connected to the hospital server from home and pulled up the patient’s x-ray films and CT scan.

Looking at the CT, I quickly saw that the patient, David Flynn, had fractured his back, and badly! Essentially he shattered, front to back, a vertebra in his thoracic spine, just below his shoulder blades.

But this wasn’t his only problem. There was evidence David had sustained multiple other fractures in the past similar to, but not as bad as the current one. On each of those three occasions, surgical cement was injected into the fracture to stabilize them. Unfortunately, that relatively simple solution would not work this time.

The radiologist thought the new fracture might be due to cancer and looking at the rest of David’s spine I had to agree. And because so much of his spine was weakened, I didn’t think anything could be done surgically to stabilize let alone correct the deformity of David’s spine caused by the fracture.

I called the ER and spoke to one of the nurses taking care of David. She told me David’s physician had put a consult into another neurosurgeon but they were told I was covering for him, so they called me. I actually became a bit upset that I was not consulted initially. But since I was only on call for my group, I told her they should attempt to contact him, and at home, if necessary.

I was later informed the other surgeon was out-of-town so as it turned out I would be taking care of David.

I spoke with the ER physician and discussed with her that since the bones above and below the fracture were damaged any attempt to stabilize the fracture would be difficult and very likely not possible. She reluctantly agreed.

The next morning, Sunday, I received a text from Chad, my PA about David and that after examining him he discovered he was partially paralyzed in both his legs. I told him I was aware of David’s injury but was totally surprised to hear about his weakness, since no one the night before told me of this critical piece of information.

Chad then relayed to me that David had probably been severely weak in both of his legs for at least two days since according to what David had told him, he hadn’t been able to walk since then.

Nevertheless I ordered that a stat MRI to be done. So, at two o’clock that afternoon Chad and I were sitting in the MRI suite waiting for the scan to be completed.

After reviewing the MRI I discovered that, in fact, there was something I could do to help David and it would not be as complicated as I initially thought it would be. First, I would remove the bone compressing David’s spinal cord and then I would inject some surgical cement into the fracture along with inserting four bone screws and two rods to stabilize the spine.

Generally, a procedure such as this requires advanced planning and since David had been weak for two days I decided that surgery could wait until the following (Monday) morning. After all the prospect of operating late into Sunday night was not something I wanted to do, not after operating late into the night Friday and working all day on Saturday.

After making several phone calls to the operating room and then to the representative for the surgical instrument company to have the necessary equipment shipped to the hospital, surgery was scheduled for early Monday morning.

Since everything had fallen neatly into place I was convinced I could (should) wait until the following morning to perform David’s surgery. But if this were the case, I asked myself, why couldn’t I leave the parking lot? As a matter of fact I couldn’t even bring myself to put the keys in the ignition. I was, figuratively, paralyzed.

Soon it became apparent to me that someone was tapping on my drivers’ side window…tap…tap…tap. TAP…TAP…TAP. But no one was there!

Deep down I knew. The Holy Spirit was trying to get my attention…and a brief struggle ensued between what I wanted to do and what I knew I had to do.

It was at that point I decided to go back into the hospital and examine David once again.

When I arrived, he didn’t seem surprised. Examining him he seemed to be weaker than what Chad had told me he was earlier in the day. Without prompting, David said, ‘You know doc, yesterday I could lift my leg and now I can’t’.

Immediately, I called the OR and let them know I would be performing David’s surgery that night and not the next morning.

Surgery went well and though there was significant pressure on the spinal cord caused by the fracture, I was uncertain, at best, if David would regain the ability to walk again.

And as it turned out my initial reluctance to do anything was because I thought David’s spine was riddled with cancer but when the pathologist examined the specimens that I sent him he did not find any cancer!

The following morning I was literally amazed. As I walked into his room, David smiled broadly and said, ‘Doc, look what I can do’! as he lifted both of his legs easily off the bed.

Truthfully I didn’t think he would recover much of the strength in legs, let alone so soon. The degree to which he improved was nothing short of miraculous.

Of course David would not be walking independently without intensive rehabilitation but at least he now had a chance which was something he did not have twelve hours earlier.

Had I waited until Monday to perform his surgery he likely would never have had that chance.

As I contemplate the events and how they unfolded for me I am deeply humbled by the power of God in my life. To be certain I must rely on the gifts of my hands and my intelligence to do the things I do. But I can’t depend totally on myself for all the answers. I must be open to Him to guide me so that I can best use the talents He has given me.

A Miracle of Words

Charlene Charles had always been a woman with a tough personality, never mincing words, and often times having ‘choice ones’ for people or situations that irritated her.

In many ways this demeanor served her well, since she had a difficult life to say the least. She survived the diagnosis and treatment for breast cancer almost twenty years ago and more recently had to undergo chemotherapy for a second cancer, lymphoma and was currently in remission.

Though she had periods of time when she saw the glass more empty than full, she managed to fight through it all.

Given this history one might feel she had been through enough, but unfortunately she had one more trial to endure.

This time, however, things progressed more rapidly and the outlook was darker than it had ever been before. One day she had been fine, and the next day, the words that came from her mouth were a jumbled mess. Speaking with her you could tell by the look in her eyes that her brain knew what it wanted to say but she just couldn’t get the words out so they made any sense.

As a result she visibly became frustrated and because of her personality she became extremely angry as well.

At times like these I kind of feel like an interpreter attempting to translate a foreign language. Because I have seen so many people with aphasia, or difficulty speaking I can almost tell what the patient wants to say just by listening to their fragmented speech even when the actual words are completely wrong.

Shortly after she was admitted an MRI scan was performed and revealed what she and her family had dreaded and I suspected…she had a brain tumor. Only it was not a metastasis from her breast cancer or the lymphoma but she had developed a third type of cancer, a malignant astrocytoma.

The following Monday I took Charlene to surgery to remove the tumor. That morning before the nurse took her back to the operating room I went and ‘spoke’ with her. Since she had been receiving a steroid medication for the brain swelling caused by the tumor, her speech was actually more clear, though still not normal. Unfortunately, because of the tumor’s location (left temporal lobe) I realized her speech might not get any better and could even be much worse.

She knew that too.

Surgery went well.

Though I knew I could not completely removed this type of cancer, I hoped that removing as much as I did would decrease the pressure on the surrounding brain enough that her speech would improve, and that her prognosis would be better as well.

I was crushed to discover that following surgery, Charlene could not speak at all. At first I believed this was probably due to my manipulation of her brain as well as the anesthesia and once these effects wore off after two or three days, she would be better. Unfortunately she still was unable to speak, and in fact she seemed to regress to the point where she would not even open her eyes or respond.

Two days after surgery I ordered an MRI scan to be performed. When I reviewed it, I had indeed removed a majority of the tumor but I clearly avoided her speech area so I was even more puzzled as to why her condition was so much worse than before surgery.

I quickly became concerned that now, she might not even make it out of the hospital alive, let alone survive for 12 – 18 months.

Her sister had arrived a few days after surgery and when I spoke to her she revealed how Charlene had on more than one occasion expressed her desire to give up fighting and just join her husband who had long since passed away.

I continued to treat her for whatever brain swelling might still be present in the hopes she would recover but after 5 days, there was no change. When I spoke with her sons later in the day, I expressed my concerns that her recovery was in doubt, as I too, began to accept the inevitable.

At the suggestion of the neurologist who had seen her I started mannitol, which is a diuretic of sorts for the brain. Surprisingly, Charlene began to awaken and become more responsive. This didn’t make sense to me from either a medical or scientific standpoint because this medication shouldn’t have had any significant effect this far out from her surgery.

What is more is that we only administered this medication for a couple of days, then stopped it, yet her improvement continued.

When I saw Charlene 9 days out from her surgery, I was dumbfounded. She was sitting up in bed speaking clearly! Not only was her speech better than before surgery, it was perfectly normal.

She then began to relate to me the ‘dreams’ she was having in the days following her surgery. The images she described sounded more like demons and monsters that were out to get her and in that moment I was reminded of a child hiding under the covers in her bedroom to escape them.

Looking back, it seemed like, to her, just a bad nightmare.

Now, how much of this was the due to the short-circuiting of the complex wiring of her brain caused by the tumor and the surgery, and how much was due to something more inexplicable, I can’t be sure.

But what is clearly miraculous is the degree to which her speech completely normalized… and I this is exactly what I told her.

At this point I am unable predict her prognosis since the post-operative MRI revealed there was residual tumor and the diagnosis was that of the worst possible primary brain tumor, a Glioblastoma Multiforme. But what is clear, is that at least for now, she has been blessed with more time to enjoy her family, and they both have the opportunity, perhaps, to say and understand the things they have been meaning to say to one another for quite some time.

P90X and ‘Spiritual’ Reps

Years ago, a big part of my life was lifting weights. I was obsessed, you might say. I worked out at least three days a week for 2 – 3 hours at a time.

One day as I was moving from the bench press to the dumbbell rack I thought, ‘I spend so much time chiseling my physical self, if I only spent half as much time on my spiritual life how much better a person I might be!’ But, the thought vanished as quickly as it came to me and I went about with my ‘bicep curls’.

It has taken me many years to get to the point where my spiritual health has taken on a more important role than my physical appearance. Although with my responsibilities at work and the time I devote to my family, helping out with homework assignments and shuttling here and there after school, exercise had been pushed way down on the list of priorities anyway.

Of course as a result my overall health has suffered. Hypertension is something I have had since medical school but diabetes is something I have acquired within the last five years or so and it has gotten worse. So clearly, my health is something I must refocus my efforts on.

But balance is the key. It is important to take care of our bodies and to be the healthiest physical version we can be, but it is equally important to be the healthiest spiritual version of ourselves as well.

 

Do you not know that you are God’s temple and

that God’s spirit dwells in you? If any one

destroys God’s temple, God will destroy him.

For God’s temple is holy, and that temple you are.

1 Corinthians 3:16-17

 

Unfortunately, it is not because we inherently want to be the healthiest version of ourselves although that may be in part, or perhaps completely, the excuse; but because we have a narcissistic desire to look better than the next guy, or girl and to be sure the world knows it.

The irony is that to be the best spiritual self we can be is more difficult to achieve. It takes a tremendous amount of humility and ‘strength’ of character; and when we become prime physical specimens it often brings out in us an attitude that is the exact opposite. After-all being in a state of perfection requires us to crush the opposition, does it not?

In reality, I believe we can be both spiritually and physically strong at the same time as long as we keep things in perspective, but it takes work… and more than bench pressing 275 lbs!

Recently I read in the book, The Measure of a Man, the importance of being meek without being weak! How is this possible?

This is an interesting concept because it would imply that our faith can be strong and when necessary forceful but without being puffed up with pride. After all Jesus warned us about showing off how ‘holy’ we are to others but rather we should keep it to ourselves so that only God knows. (Matthew 6:1-6)

Of course we are human and by our nature we often fail.

Recently, a friend of mine mentioned the workout routine P90X and how it was really effective but that the workouts were intense and that the diet was something you had to stick to. So I decided I would try it out. Besides you could do the workout as intensely with resistance bands instead of weights, which appealed to me because I had injured myself in the past with weights.

I admit the food is not always a gastronomic delight but I have lost weight and in fact my diabetes has been impacted tremendously. And at this point in time, practically speaking, I am not taking any diabetes medication at all! So this has been the greatest motivator for me and my appearance becomes a by-product of my health, and not the other way around.

However…just the other day as I left my Friday morning men’s group I was focused on getting home and performing my workout for the day. But the parish school where my children attended was about to go to morning mass and in the back of my mind I thought I should go too. But that workout loomed large over me.

That’s when I stopped and began to listen to ‘God’s’ voice in my head… ‘Here you are being somewhat critical of those who are obsessed with THEIR workouts and now you are becoming the same way about YOURS!’

I knew He was right, and besides I had nowhere special to be that morning and I could exercise afterwards… so I turned my truck around and returned to the church parking lot. Of course it was a wonderful mass and I was so glad I went. To think I could have lost that important moment in my life and that of my children.

The other day I joked with my wife Stacy that not only was I doing the P90X workout but also one that was more important, the Alpha and Omega X workout! She looked at me a bit perplexed, as I reminded her…

 

“I am the Alpha and the Omega,”

says the Lord God, who is and who was

and who is to come, the Almighty.

Revelations 1:8

 

For me, making Christ, a part of my daily ‘workout’ is what helps me achieve this balance… although as with anything that is worth having, it takes hard work.

A Physician Greater than I

I had just finished operating for the day and I had a meeting to attend but I told my wife before the meeting, I would join her and the children for a quick picnic, and if I didn’t leave soon I would be late. To say I was rushed was a bit of an understatement, but first I had to run up to the ICU and quickly see Nora Horace who I was scheduled to operate on the next day for metastatic breast cancer to the brain.

Nora had been diagnosed with breast cancer several years ago and had undergone treatment, including chemotherapy, but a recent PET scan was clear. So it was quite a shock when the emergency room physician told her she might have a brain tumor.

Nora had been having some imbalance and unsteadiness walking but she thought it might have been side effects from the chemo, but when it got worse, she and her close friend Diane felt it best to have it checked out further.

She actually had been admitted the evening before and I had been called during the afternoon and was told of her case. So when I reviewed the CT scan, I ordered an MRI to be done the following morning and told the nurse I would be by to see Nora the next day after I finished operating.

The MRI indeed revealed a large tumor in her left cerebellum which is the area of the brain responsible for coordination; in addition the pressure it exerted on the brain around it, caused compression and partial obstruction of the flow of cerebrospinal fluid within the brain. This was even more critical because if the flow became completely blocked off, the pressure within the brain would reach a life threatening level.

So it was clear I had to operate to remove this tumor. Unfortunately, Nora also had three ‘pea-sized’ tumors elsewhere in her brain which indicated her metastatic disease was more widespread.

As I walked into her room, she greeted me in a warm way similar to what I had experienced at a resort in the Bahamas many years before. This was her nature because she, in fact, was from one of the islands in the Caribbean.

I brought up the images of her MRI on the portable computer to show her and her friend the nature of the problem. After I finished describing the findings on the MRI and explaining the surgery I had planned, I fully expected her to be like most patients, a bit shocked, a bit depressed but resigned to what needs to be done. At that point most patients say ‘ok, whatever you say doc’. My reply is often a bit curt as I nod and tell them I will see them in the morning, as I turn to leave.

And this day I had planned on it playing out that way, so I could be on my way to where I had to be.

But what she said, stopped me… dead… in my tracks.

Nora then replied, ‘I am not afraid doctor… I know the Great Physician… do you know Him?  I said ‘Yes I do…very well.’ She said ‘that is good because sometimes when I ask people, do you know Jesus Christ? They tell me he was just some guy.’ I continued, ‘No, He is way more than just a guy’.

She then asked if I prayed to Him to guide me before I operate and I replied, ‘all the time’. Nora then asked, ‘Well tomorrow before you operate on me’, as she pointed to the sky, ‘I want you to call Him… collect!’ Practically with tears in my eyes, I promised I would.

I shook her hand with both of mine and told her I would see her in the morning, as I slowly turned, to walk out of her room.

Going into the surgery I anticipated that removing the tumor would be fairly easy, since most tumors of this type are not adherent to the surrounding brain. As it turned out removing the tumor was extremely difficult and I spent no less than six hours micro-surgically teasing the tumor out.

The amazing thing to me was that throughout the procedure, ‘ideas’ would pop into my head on how to proceed, which were not necessarily techniques that I usually employ. As a result I was able to completely remove the tumor without any complication whatsoever.

As I was finishing up, I thought about this, realizing that God had been with me and by my side guiding me every step of the way.

The following morning, I examined Nora and found her to be completely normal neurologically. Though the pain of the incision caused her to wince, she said ‘I am grateful to God, grateful that you are a Christian, and grateful that He worked through your hands to help me’.

for she said to herself, “If I only touch his garment,

I shall be made well.” Jesus turned, and seeing her he said,

“Take heart daughter; your faith has made you well.”

And instantly the woman was made well.

Matthew 9:21-22

Hearing a Voice in the Wind

I had just finished my second case of the day, a cervical fusion, when Chad, my PA got a consult to see a patient at Countryside Hospital.

Aaron Cook, 81 had been diagnosed with multiple myeloma, which is cancer of cells in the blood that accumulate in and weaken the bones of the body.

Chad had spoken to the nurse and was told, Mr. Cook was paralyzed in his legs.

An MRI of his spine revealed that the cancer had replaced most of the bones of his spine. In his mid back, the cancer had weakened so much of one of the vertebra that it crushed upon itself. As a result the bone and cancer cells were pushed back into Mr. Cook’s spinal cord causing his paralysis.

Given Mr. Cook’s age, his paralysis, and the appearance of his MRI my initial reaction was that there wasn’t much that could be done. I spoke to his physician, Dr. Reynolds, who told me Mr. Cook had initially presented with severe back pain.

But because the cancer was so widespread it was concluded by the oncologist and radiation specialist that any treatment would be palliative, which basically meant the cancer could perhaps be slowed down but not cured.

Dr. Reynolds informed me Mr. Cook had been in the hospital about ten days receiving radiation treatments to his spine. ‘The excruciating back pain that he had on admission had subsided’, he continued, ‘but now he was unable to get out of bed because his legs were paralyzed’.

I told Dr. Reynolds that it was unlikely anything could be done surgically to help Mr. Cook but that I would go by and evaluate him if he wished. He said that would not be necessary. He just wanted me to look at the films and let him know if there was anything that should be done.

As soon as I hung up I was called back to OR room #4 for my next surgical case of the day. I finished up operating at about 6pm, and after I dictated my surgical note and checked on my post-ops I thought about Mr. Cook. I knew I wasn’t expected to see him but I felt compelled to drive over to Countryside Hospital and see him nonetheless.

As it turned out I had performed surgery on Mr. Cook’s wife many years earlier so he knew me, and in fact, he was expecting me. As I talked to him about how he wound up in the hospital he told me that up until about 4 weeks ago he was just fine. He and his wife had gone over to the Florida east coast but because he ‘just didn’t feel right’ he told his wife they needed to cut their trip short and return home.

When I was given his history earlier in the day I just assumed he had been diagnosed with multiple myeloma several years ago and that now his MRI revealed the end stages of the disease. But he had just been diagnosed 10 days ago.

When I examined him, I discovered he was ‘paralyzed’ in his right leg but that the strength in his left leg was only mildly weak. I then discussed with him options and prognosis. ‘In most circumstances such as yours I would remove the crushed vertebra and replace it with a metal or plastic cage filled with bone’, I told him. ‘Then I would place screws and rods in the spine above and below the fractured vertebra to stabilize it’, I continued.

‘But because the cancer had affected so much of your spine, I can’t do any of that. And because of your age, I’m not sure you would survive such an extensive surgery anyway’, I concluded.

‘So, what does that mean’, he asked. ‘Well’, I said hesitantly, ‘I’m not sure you will ever walk again’.

Choked up, Mr. Cook said, ‘Oh my God, my wife is too ill to take care of me…’ Looking down at him lying in his bed, still in pain and unable to get up and walk, I was sorrowful, wishing there was something I could do, yet realizing surgery was too risky.

I told him I was sorry and that perhaps with continued radiation treatments, he still might get better, although I knew this was not likely.

As I stood at the nurse’s station writing my progress note in Mr. Cook’s chart, I felt compelled to look at his MRI scan again. As I flipped through the images I thought to myself, ‘there’s got to be something I could do that might help’.

I called Chris, one of my colleagues to discuss his case. He too, agreed that Mr. Cook at 81 years-of-age would never survive a major surgery. But perhaps if I removed some of the bone from the back part of the spine, he suggested, this would free up enough of the pressure on the spinal cord so that his strength might improve to the point where he could walk again.

I thanked him, hung up the phone and walked back into Mr. Cook’s room.

I told Mr. Cook that I had given his problem more thought and there was something I could do surgically that might help him. ‘However, while I cannot promise you it will be successful, I think it may be worth the risk’. Not surprisingly he was willing to take that chance.

I spoke to Dr. Reynolds and explained my plan who then agreed to have Mr. Cook transferred to the hospital where I would perform surgery in the morning.

Surgery went well and though the cancer had destroyed most of that particular vertebra I was able to relieve the pressure on Mr. Cook’s spinal cord. Over the ensuing weeks following surgery Mr. Cook gradually regained strength in his leg and began to walk using a walker and some assistance.

For me, Mr. Cook’s case reinforced to me the importance of several things. The first is that nothing replaces talking to and examining the patient myself.

Not only does this allow me to get a real sense of the patient’s problem but also helps me to understand the true impact of the illness on the patient and his (or her) life.

In Mr. Cook’s case I initially dismissed ‘out of hand’ that anything could or should be done surgically in someone who had widespread cancer. However after speaking to him I realized he was living a normal life just 2 weeks earlier. Not only that but his wife was very ill herself and there was no way she could take care of him.

So as I stood there leaning up against the counter at the nurse’s station, I felt a change of heart. Was it merely my sense of compassion… or was it an angel, or the Holy Spirit that inspired me, reminding me I was given my gift to help others.

And so, grateful once again for be able to hear that voice in my head, I did what I could to help Mr. Cook, and his wife.

“The wind blows where it will, and you hear the sound

of it, but you do not know whence it comes or whither

it goes; so it is with every one who is born of the Spirit.”

John 3:8